Insurance Coverage of Varicose Veins : ADLs

What Are Activities of Daily Living?

To start with, ADL means “Activities of Daily Living”. Insurance companies are not in the business of paying for cosmetic treatments; therefore, an expectation is put in place before consideration of varicose vein treatment. One of those expectations is that your activities of daily living are affected. This tends to be hard for one to understand exactly what “affected” means; many of us will do our best to get through our responsibilities whether it is leg pain, headache, back ache or other ailments that come our way. Even though we are working through some of this pain there are times we are unable to complete some things or do some things on the timeframe needed because of the leg pain we’re experiencing. When asked, “how are your ADL’s affected?” some responses are as follows:

“At the end of a long day I am unable to do the dinner dishes before I have to sit and elevate my legs.”

“My job requires me to sit for long periods of time and makes it very difficult to do my work without standing and walking around.”

“After chasing my children around in the morning it takes some rest before taking them to the park or caring for them such as bathing or dressing.”

“I am unable to complete my chores around the house without sitting and elevating my legs.”

“I would like to do more yard work but after a short period of time I have to take a break.”

“My life could use more exercise but my leg pain limits how far I can walk before heading home.”

“My job requires me to stand for long periods of time; I am in a great deal of pain by the time break is called. The pain is effecting how I do my job.”

This list could go on and on in different ways of how your daily activities are being affected and from this list you may realize that you do experience heaviness, achiness or tired legs that limit what you do throughout your day. You may get cramps in your legs at the end of the day or at bed time that wakes your from your sleep, especially after a long day on your legs.

Do You Relate?

If some of this is starting to resonate with you it’s time to schedule an appointment to assess your vein anatomy. At this appointment we will be able to evaluate your vein sizes for an appropriate treatment plan, which is also a requirement your insurance company will need. We will also be able to explain further insurance requirements which may include compression stockings, Non-steroidal anti-inflammatory drugs and leg elevation. We are here to help you understand the process better and work directly with your insurance to help you overcome the pain.

Varicose Vein Procedures: Endovenous Thermal Ablation

Endovenous Thermal Ablation

The first procedure typically performed is the venous ablation. This is where the vein is burned with either laser or radio frequency catheters. During this procedure, the patient is sedated with valium, nitrous oxide, or both. The patient can choose the level of sedation they prefer.

During this procedure, the sonographer will map the vein to be ablated and mark a location that appears to be a good access point. What we look for is whether the vein is straight and has a large diameter, which makes accessing the vein easy. Veins will sometimes spasm or be a smaller diameter early in the morning when the patient hasn’t been standing or active all day, or when the leg is cold. In these cases, we use gravity, a Nitroglycerin patch, and a blanket to help warm up the leg and increase the diameter of the vein.

Once a location is marked, we prep the leg with a cleansing/sterilizing solution and set up the procedure using sterile technique. We ask that the patient not touch the sterile field, so to prevent infection. When the physician enters the room, he will also dress in a sterile gown and will don sterile gloves. We take every precaution to keep the patient safe and infection free.

At this point, the physician will access the vein and start the procedure. Once the vein is accessed, a “guide” wire is inserted and the sonographer will follow the wire up the vein to make sure we are in the vein and not in the surrounding tissue. After that, the catheter, with the heating element, is inserted and once again the sonographer follows the catheter with ultrasound to make sure it is in the vein to be treated.

Once the catheter is an acceptable distance from the deep venous system, we need to numb around the vein. This is two-fold: The first reason is to numb and protect the tissue surrounding the treated vein from being burned. The second is to compress the vein around the catheter so the walls of the vein will be treated.

Once this all complete, the catheter is slowly removed and the vein will be ablated. We close the access point with steri-strips and the procedure is finished. The patient is then required to wear a compression stocking for one week.